Assessing the predictive value of teacher reports in a high risk sample for schizophrenia: a ROC analysis

We examined teachers' reports to determine early patterns of school behavior that identify children who were diagnosed schizophrenic in adulthood. High risk subjects (n = 207) in the Copenhagen High Risk for schizophrenia project were examined on a 25-item questionnaire completed by teachers. A likelihood ratio approach was used to create a classification index relating school report to DSM-IIIR diagnoses made 31 years later. A standard receiver operating characteristic (ROC) analysis was used to evaluate the efficacy of the classification indices for distinguishing preschizophrenics from children who later developed schizotypal disorder, other nonpsychotic disorders, and no mental illness. Different items predicted schizophrenia in males and females. To a significantly greater degree than their controls, preschizophrenic males were lonely and rejected, behaved inappropriately, were disciplinary problems, emotionally high strung, and were more likely to have repeated a grade; preschizophrenic females were nervous and passive. Both preschizophrenic males and females were judged by teachers to be vulnerable to future psychotic problems. These findings are consistent with our preliminary findings, as well as with other research. They highlight the ability of teachers to identify school behaviors that may be used to select future schizophrenics for early intervention.